Study Finds that Being Uninsured Does Affect Health Outcomes for Children in Hospitals

Posted on: October 31, 2009  |   Author: Asha
Filed Under: Access to Care, HMOs & Health Plans, Healthcare Reform, Insurers/Payors, Other   |   Leave a Comment

The Children’s Center at Johns Hopkins conducted a study including 23 million children from 37 different states between 1988 and 2005. The study showed that uninsured children hospitalizations compared with children having either private or government insurance had a 60 percent higher chance of dying. The study also indicated that at least 1,000 hospitalized children died annually due to a lack of insurance. This means that uninsured children deaths comprise nearly half of all children deaths nationally.

Though the study was not directed at cause, the study also showed that uninsured children are more likely to end up in emergency rooms, where the condition may have worsened by the time care is administered. The time spent in a hospital between insured and uninsured children varied. On average, uninsured children were in the hospital for less than a day when they died. Overall hospitals charges for uninsured children was significantly less than for insured children (less than half).

The author of the study, Dr. Abdullah, did not believe in a causal connection between the amount of care providers gave and insurance status. He noted that children often arrived at the hospital too late for any revival to occur.  These discrepancies are unique because children do not die often. However, nearly seven million children remain uninsured in the United States.  This study helps to show the vast disparate health outcomes that not having insurance can create. According to the Congressional Budget Office, 14 million children will be covered by CHIP by 2013.

Commentary: As the article mentions, such studies help shine light on a moral obligation we face in granting children insurance. Their insurance status is not a choice but a predetermined situation. Uninsured children are more likely to have unmet medical needs, which leads to poorer quality of life. Having such a high number of uninsured children also contributes to overall costs to the health care system, as these children are more likely to end up in emergency rooms where services are expensive and may not be of the highest quality. Thus, it is to the benefit of society overall to keep the number of uninsured children as low as possible

The New York Times, October 30, 2009.

Tough Choices: A Blurb About the Difficult Choices Facing Many Couples in Their Quest for Fertility

Posted on: October 31, 2009  |   Author: David
Filed Under: Drug & Device, HMOs & Health Plans, Health Information, Hospitals & Health Systems, Insurers/Payors, Technology   |   Leave a Comment

It may be one of the hardest decisions an expectant parent would have to make: Reduce the number of fetuses you are carrying or risk losing them all.

Sadly, that is exactly the decision Thomas and Amanda Stansel had to make. After undergoing the popular process of intrauterine insemination in which sperm is injected into Mrs. Stansel’s uterus following hormone injections, Mrs. Stansel received shocking news – she was carrying not one, not two, but six fetuses. However, the Stansel’s excitement was soon crushed when their fertility doctor gave them some additional startling news. Due to the increase in fetuses, the likelihood of delivering six healthy infants was near zero. To save some, he recommended reduction – through a process known as “selective reduction.” The Stansels decided not to reduce, instead relying on their faith to protect them and in August, Mrs. Stansel gave birth to all six babies. Unfortunately, at 14 weeks premature, all weighed in at roughly one pound. The hospital fought valiantly, but three babies died within two weeks. A few months later, another was lost. The two babies remaining continue to struggle, still attached to ventilators and feeding tubes and under constant care in the hospital neonatal intensive care unit.

For couples having difficulties becoming pregnant, there are several options available. First, most doctors recommend utilizing low-potency fertility drugs in order to stimulate the process. If unsuccessful, the next step is intrauterine insemination with hormone injections or in vitro fertilization. This decision is often influenced by two related factors: insurance and costs. The cost of in vitro fertilization costs between $12,000 and $25,000 while intrauterine insemination only costs $2,000 to $3,000 per attempt. As such, many insurance companies will cover multiple rounds of intrauterine insemination before one round of in vitro fertilization. The preference though, is not without drawbacks. Intrauterine insemination, while front-end cheaper, can present significant problems. Excessive hormone injections can lead to an overstimulation of the ovaries which in turn can lead to the increase in probability of having multiples. In fact, the Centers for Disease Control and Prevention supported this theory when it found that the intrauterine insemination process was more likely to result in multiples than in vitro fertilization. And with increased multiples, come increased risks, especially with premature births which carry the risk of long-term complications and disabilities. Multiples, like the Stansel babies, who arrive early, require the highest level of acute care for a longer time than any other patients. This can add up to astronomical financial hardships in the long-run. In addition to money, multiples with increased risks of complications can put families in very difficult decision like the one faced by Thomas and Amanda Stansel- whether to abide by religious beliefs against the perception of abortion or a doctor’s recommendations to reduce.

The current position taken by insurance companies is baffling. Intrauterine insemination is largely undocumented today, but has been shown to be less successful and more dangerous (with respect to increasing risks for premature multiples) than in vitro fertilization. The main upside, cost. Due to the less invasive nature of intrauterine insemination there is a significant cost difference between the two procedures leading many insurance companies to favor the treatment. In doing so, insurance companies may be overlooking two major issues. One, as this procedure becomes more popular, the costs associated with premature multiples will also grow- likely at a much higher rate than the cost of the initial fertility treatment. Second, many couples attempting to start a family do not understand the possible consequences of their actions – the psychological and financial considerations of having a tragic result. Insurance companies have long acted as a gatekeeper in providing medical treatment and should take a second look at their current preference towards intrauterine insemination.

The New York Times, October 11, 2009.

Health Reform: Opportunities for People with Disabilities and Chronic Illness

Posted on: October 22, 2009  |   Author: Sidney Watson
Filed Under: Access to Care, Bioethics, Disability, HMOs & Health Plans, Healthcare Reform, Medicaid, Medicare, Other, Tax & Finance   |   Leave a Comment

Despite the noisy demonstrations during the August town hall meetings and a great deal of misinformation spread through email, the internet, talk radio and other media, there is wide scale agreement that the U.S.’s private health insurance system is broken:  Private insurers refuse to cover individuals who need medical care; even middle-income families are priced out of private insurance; and businesses, already reeling in the economic downturn, are straddled by skyrocketing health insurance premiums.

There is also significant consensus in Congress on the framework for health reform legislation.  Daily headlines that focus on differences in opinion on specific provisions of the reform bills suggest that bipartisan and even Democratic Party agreement is elusive.  However, all the bills moving through Congress use the same framework:

(1) reforming private health insurance, (2) guaranteed affordable health insurance for all; (3) using a Health Insurance Exchange to reduce the cost of insurance in the individual and small group markets, (4) increased choices, and (5) shared responsibility.

All the proposals under consideration by Congress build on what works in today’s health care system, fixing the parts that are broken.  They protect current coverage-allowing individuals and employers to keep the insurance they have it they like it-and preserve choice of doctors, hospitals and health plans.

The bills also do what the ADA did not: They change the way private health insurance is priced and structured.  No longer will private insurers be able to refuse to cover people with disabilities and chronic illness.  No longer will they be able to price out those who need medical care or design insurance packages that fail to cover important services that people need to live and work in the community.  All the proposals offer people with disabilities increased options for health insurance and health care.

Overview of Process in Congress So Far: Three House Committees have acted: Education and Workforce, Ways and Means, and Energy and Commerce.  Two Senate Committees have acted:  The Senate Health, Education, Labor and Pensions (HELP) version is the most ambitious and far-reaching bill among the drafts. The Senate Finance Committee passed its version on October 13.  It is the least costly and least ambitious of the five bills.

What Comes Next: The three House Committee versions will be combined into one bill that will be voted on by the House of Representatives.  On the Senate side, the Senate Finance Committee and the Senate HELP hope to have a merged version of their two bills this week.  Their one bill will go to the Senate Floor for a vote.

FRAMEWORK FOR REFORM

Private Health Insurance Reforms

All the proposals change how private insurance companies do business to guarantee access to health insurance, prohibit discrimination based on health status.  They all:

Guaranteed Affordable Health Insurance

All the proposals provide for sliding scale premium subsidies for people purchasing insurance through the Exchange to make insurance affordable for lower and middle income families.

All expand Medicaid to cover all low income individuals and families under age 65 with incomes up to 133% of Federal Poverty Level.  This will cover an estimated 11-14 million uninsured.

Creation of a “Health Insurance Exchange”

An Exchange is a new entity that will allow for one-stop shopping for health insurance so individuals can compare options and enroll in the plan that best meets their needs, at the best price. Health insurers offering plans through the exchange will be required to comply with the new health insurance reform rules for issuing and pricing policies.

Increased Choices

The most contentious issue is whether individuals and small businesses purchasing health insurance through the Exchange should have the option to enroll in a new health insurance plan, not controlled by private health insurance companies.

Shared Responsibility

Everyone is worried about who will pay for health reform, but the key to making coverage affordable is for everyone to do their part.

Paying for Reform

While the federal budget price tag for expanded health coverage seems staggering–$829 to $1 trillion over 10 years-this amounts to only about 2-3% of total health care spending.  Overall-counting private as well as public spending-it will cost us more to do nothing.

Delivery System Improvements

All the plans provide, in different ways, for a variety of delivery system reforms aimed at creating real systems of care that are patient centered including

Provisions providing support for more Community Based Services in some but not all the bills….

New Medicaid Community First Choice Option creates a new state plan option to provide community-based attendant services.  (Senate Finance)

Medicaid Community services as alternative to nursing home care FMAP increase to states that make Medicaid structural changes than have proven to increased nursing home diversion and expand use of HCBS. (Senate Finance)

Improved Medicaid spousal impoverishment protection requiring states to apply protections for nursing home residents to HCBS. (Senate Finance)

Community Living Assistance and Support (CLASS) Act would create a national insurance program to help pay for community living services and supports. (Senate HELP & House)

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